Rate of pseudophakic cystoid macular edema using intraoperative and topical nonsteroidal antiinflammatory drugs alone without steroids

Abstract

Purpose: To determine the rate of postoperative cystoid macular edema (CME) in patients undergoing cataract surgery treated with intraoperative intracameral and postoperative topical nonsteroidal antiinflammatory drugs (NSAIDs) without steroids. Setting: Academic outpatient surgery center Wake Forest Baptist Health in Bermuda Run, NC. Design: Retrospective cohort study. Methods: A retrospective chart review was performed. Patients were identified through a medical record search tool using criteria of the Current Procedural Terminology code (66984), a single surgeon, and a date range from January 1, 2016, through December 31, 2017. Medical records were reviewed to determine intraoperative and postoperative medication regimen, visual outcome, and development of postoperative CME. Patients with a history of uveitis, diabetic macular edema, retinal vein occlusions, epiretinal membranes, vitreomacular traction, or any prior macular edema were excluded. In addition, any patients with less than 6 weeks of postoperative follow-up were excluded. Results: Overall, 824 patient records were reviewed, and the analysis included 504 eyes. Of these, 2 eyes developed postoperative CME (rate = 0.40%, 95% CI 0.0005 to 0.0143). Conclusions: The rate of CME in patients treated with intraoperative and postoperative NSAIDs without steroids was low and below the historical rates derived from a literature review of CME development with the use of steroids.

Safety and efficacy data supporting U.S. FDA approval of intracameral phenylephrine and ketorolac 1.0%/0.3% for pediatric cataract surgery: clinical safety and pupil and pain management

“…[11][12] PE/K has also been shown, compared to epinephrine, to reduce by multi-fold the incidence of cystoid macular edema while eliminating the need for perioperative steroids. [13][14] In addition, use of epinephrine may be a less desirable option since it is off-label and has had supply shortages in the past. Off-label preservative-free PE is also used in cataract surgery to support pupil dilation.…”

Treatment of Macular Edema in Vascular Retinal Diseases: A 2021 Update

“…Corticosteroid eyedrops are prescribed postoperatively by most cataract surgeons to prevent the formation of PCME [5]. Topical steroids, non-steroidal anti-inflammatory eye drops, and ocular steroid injections (sub-tenon or intravitreal) are the main treatment options for PCME [2].…”

Case Report: Subconjunctival Bevacizumab for the Treatment of Refractory Pseudophakic Cystoid Macular Edema

“…7 Hence, anti-inflammatory treatment modalities are usually used for the treatment of this macular edema. Nonsteroidal anti-inflammatory drugs, 8 systemic interferon alfa-2a, 9 corticosteroids, 4,10 vascular endothelial growth factor inhibitors (anti-VEGFs), 4,11 and pars plana vitrectomy 4 have had various therapeutic effects on pseudophakic cystoid macular edema in clinical practice. Although intravitreal injections of corticosteroids and anti-VEGFs have been found to be effective in treating pseudophakic cystoid macular edema, they may carry some risks, such as the following: sterile or infective endophthalmitis, elevated intraocular pressure (IOP), vitreous hemorrhage, vitreous incarceration, retinal break or detachment, and impaired wound healing.…”